老年性黄斑变性的治疗概况

老年性黄斑变性是一种常见致盲性眼病。由于其发病机制不明了,尚无确切疗法。目前,治疗多围绕脉络膜新生血管的抑制或消退而展开。光动力学疗法、激光光凝及手术治疗适用于部分患者,有一定的效果,传统中医药的治疗也有其独特的疗效,近年来,抗血管内皮生长因子(抗VEGF)制剂的开发也使AMD的治疗出现新的曙光。     

抗血管内皮生长因子的眼科应用

眼底病是眼科疾病的主要组成之一,是造成视力损害的重要原因,其中视网膜脉络膜血管性疾病的地位举足轻重。新近研究发现,众多眼底血管疾病与血管内皮生长因子(vascularendothelial growth factor,VEGF)的过度表达有关。湿性年龄相关性黄斑变性(age-related maculardegeneration,AMD)又称新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneration,n AMD)特征性表现为视网膜或脉络膜异常新生血     

Ranibizumab治疗新生血管性老年性黄斑病变

血管内皮生长因子(VEGF)具有增加血管通透性、诱导产生新生血管的特性,在老年性黄斑病变(AMD)的发生起到非常重要的作用。Ranibizumab是一种可以与所有VEGF亚型竞争性结合的抗体片段,经玻璃体腔注射后,可透过视网膜各层,到达视网膜色素上皮-脉络膜复合体。动物试验表明,该药物即安全又有效。后来,在对新生血管性AMD患者进行I期、II期的临床试验时表明有良好的安全性,对于改善视功能有显著疗效。Ranibizumab治疗新生血管性AMD时,每隔4周进行一次,目前此药处于III期的临床试验阶段。旨在增加治疗持久性及有效性的联合治疗方法,与一…     

内皮抑素抑制脉络膜新生血管基因治疗的研究进展

脉络膜新生血管(choroidal neovascularization, CNV)又称视网膜下新生血管,是来自脉络膜毛细血管的增殖血管穿过Bruch膜,在Bruch膜与视网膜色素上皮之间增殖所成,这种病变多发生于黄斑视网膜神经上皮下,造成严重视力损害.它是年龄相关性黄斑变性(age-related macular degeneration, AMD)等多种眼底疾病的病理基础,其发病率高,至今尚无有效的治疗方法,目前CNV的临床治疗有激光光凝、光动力疗法、经瞳孔温热疗法、手术剥离CNV,黄斑转位手术及放射治疗等,但复发率高、不可避免损伤正常眼组织结构、加重或诱发玻璃体视网膜增殖、造成视功能进一步恶化等.因此,寻求抑制视网膜和脉络膜新生血管生成的药物疗法,是当前眼科学临床上急需解决的一个问题.     

玻璃体腔内注射Bevacizumab对视网膜静脉阻塞继发黄斑水肿的疗效评价

视网膜静脉阻塞是目前一种常见的视网膜血管疾病,其继发的黄斑水肿是导致视力下降的最主要的原因。血管内皮生长因子( VEGF)在视网膜静脉阻塞继发黄斑水肿的发病中起重要作用。目前临床上以玻璃体腔内注射抗VEGF抗体Bevacizumab来治疗多种眼部新生血管性及渗出性疾病,但其对视网膜静脉阻塞继发黄斑水肿治疗的长期效果及安全性尚有待多中心研究进一步证实。作者就这方面的研究进展作一综述。     

息肉状脉络膜血管病变治疗中国指南（2022）（英文）

背景 在中国，新生血管性年龄相关黄斑变性患者中约有40%患有多灶性脉络膜血管病变（polypoidal choroidal vasculopathy,PCV）。PCV会导致反复视网膜色素上皮脱离（pigment epithelium detachment, PED）、广泛的视网膜下或玻璃体内出血，以及严重的视力损失。近年来，已有多种该病的治疗方法在中国使用，临床医生需要获得治疗PCV的全面经验。方法 由14名具有专业背景的眼科专家形成指南专家组，重点关注如下方面问题和相应的结局：非活动性PCV患者的治疗选择；未经治疗的PCV患者的治疗选择，包括抗血管内皮生长因子（vascularendothelialgrowth factor,VEGF）单药治疗、光动力疗法（photodynamictherapy,PDT）单药治疗或联合治疗；抗VEGF负荷治疗后仍有持续性视网膜下液（subretinal fluid,SRF）或视网膜内液（intraretinal fluid,IRF）的患者，以及伴有大量视网膜下出血的患者的治疗选择。证据整合团队在各个问题下进行系统评价，为推荐意见的形成提供依据。本指南...     

抗血管内皮生长因子药物在视网膜静脉阻塞继发黄斑水肿的应用进展

继发黄斑水肿是视网膜静脉阻塞引起中心视力下降的最常见原因,严重影响患者的生活质量.抗血管内皮生长因子药物的研究为治疗视网膜静脉阻塞继发黄斑水肿开辟了一个新的方向.笔者就哌加他尼钠、贝伐单抗、雷珠单抗及阿柏西普4种抗血管内皮生长因子药物在治疗视网膜静脉阻塞继发黄斑水肿方面的应用进展进行综述.     

视网膜颞上支静脉阻塞疗效分析

目的:观察视网膜颞上支静脉阻塞合并黄斑水肿,经眼底荧光血管造影(Fundus Fluorescein Angiography,FFA)检查确认为缺血型合并弥漫性黄斑水肿的患者,视网膜激光光凝和非光凝治疗对视力和黄斑水肿消退及视网膜新生血管的影响。方法:将65例视网膜颞上支静脉阻塞合并黄斑水肿的患者65眼,根据患者对激光治疗的依从性分为激光光凝治疗组和非光凝治疗组,激光光凝治疗组采用半导体激光治疗,非光凝治疗组采用药物治疗。随访比较两组患者视力、黄斑水肿改善方面的差异及视网膜新生血管的发生情况。结果:激光光凝治疗组与非光凝治疗组在视力恢复、黄斑水肿消退及视网膜新生血管发生率的差异有统计学意义(P<0.05)。结论:视网膜颞上支静脉阻塞眼的激光光凝治疗较非光凝治疗更有助于促进视力恢复和黄斑水肿的消退,可以明显的降低视网膜新生血管的发生率。     

光动力治疗老年黄斑变性脉络膜新生血管的临床观察

<正>光动力疗法(PDT)又称光敏疗法、光化学疗法,是目前眼科治疗的新进展,正受到医学界的普遍重视,主要用于眼科肿瘤治疗,主要集中在眼部的黑色素瘤和视网膜母细胞瘤,而用于治疗眼科非肿瘤性疾病多见,主要有老年黄斑变性(AMD)、脉络膜新生血管(CNV),特别是对老年AMD的治疗机制较为明确,疗效令人满意。老年AMD系眼底新生血管异常增生,虽为良性病变,但发病率高,对视力影响严重。PDT     

抗血管内皮生长因子药物在视网膜疾病中的应用及研究进展

血管性视网膜疾病是一类以视网膜出血、渗出和血管异常增殖等为主要特征的疾病。既往的治疗方式有保守治疗、激光光凝治疗和手术治疗等。抗血管内皮生长因子（vascular endothelial growth factor,VEGF）显著升高与视网膜血管性疾病的发生发展有密切的联系。因此，抗VEGF药物应运而生，它的出现推动了此类视网膜疾病药物治疗的革命性发展，凭借其能使新生血管快速消退、减少渗漏、促进积血吸收等优势被广泛用于治疗各种血管性视网膜疾病，如年龄相关性黄斑变性（age-related macular degeneration,AMD）、糖尿病视网膜病变（diabetic retinopathy,DR）、视网膜静脉阻塞（retinal vein occlusion,RVO）等，并取得了一定效果，但长期疗效有待进一步研究。同时，抗VEGF药物的特异性较差，也为临床用药带来了一定的安全隐患。此外，频繁眼内注射也增加了眼内感染的概率。所以新给药方式的开发、缓释药物的研制以及更多靶向新药的研发将会给抗VEGF药物在眼科中的临床应用带来更广阔的前景。     

经巩膜视网膜下液引流及冷凝术联合康柏西普治疗3期外层渗出性视网膜病变疗效观察

目的 研究经巩膜视网膜下液引流及冷凝术联合玻璃体腔注射抗血管内皮生长因子(VEGF)对3期Coats病的疗效。方法 回顾性分析1l例(11眼) 3期Coats病的临床资料,患者年龄2-16岁;其中男性10例,女性1例;3A期Coats有7眼(部分视网膜脱离),3B期Coats有4眼(完全视网膜脱离)。所有患眼接受经巩膜视网膜下液引流及视网膜异常血管冷凝术,联合玻璃体注射抗VEGF药物。主要疗效指标为最佳矫正视力,眼压,视网膜复位情况。结果 术后患者随访6-20个月,平均随访11 ± 3月。随访结束时11例患者中,视力提高8例,视力无变化1例,视力下降1例,视力检查不配合1例;3A期患者术后视力(1.10±0.50)较术前视力(1.81±0.95)提高,差别有统计学意义(p=0.0196, N=7)。新发生斜视1例(患者年龄小视力差);9例视网膜达到完全复位,2例仍有局限视网膜脱离,随访中未发生其他并发症。结论 经巩膜视网膜下液引流及冷凝术联合玻璃体腔注射抗VEGF药物是一种有效治疗3期Coats病的方法,患者视网膜复位率高,能有效挽救视功能。     

An update of treatment options for neovascular age-related macular degeneration.

OBJECTIVES: To review the role of conventional and new treatment modalities in the management of neovascular age-related macular degeneration. DATA SOURCES AND EXTRACTION: Literature search of Medline till March 2007, using the key words/terms 'treatment' and 'age-related macular degeneration' to retrieve relevant original papers and review articles. DATA SYNTHESIS: Age-related macular degeneration is the leading cause of irreversible visual loss in the elderly in developed countries. Neovascular age-related macular degeneration has a relentless course and the consequent visual loss is debilitating. Successful treatment has always been a challenge due to poor understanding of its pathogenesis. Laser photocoagulation and photodynamic therapy with verteporfin are the standard conventional treatments. However, these approaches do not prevent disease recurrence and repeated treatments are required. Recent advances in understanding the molecular pathway for the angiogenesis of neovascular age-related macular degeneration enables exploration of new treatment approaches. Antiangiogenic therapy with anti-vascular endothelial growth factor agents, such as pegaptanib and ranibizumab, have recently been approved for clinical practice. Other antiangiogenic agents include bevacizumab, triamcinolone, and anecortave are also being evaluated in clinical trials. Additional treatment modalities include transpupillary thermotherapy and surgical intervention. CONCLUSIONS: Regarding patients with neovascular age-related macular degeneration, increased understanding in its pathogenesis coupled with rapid development in instrumental technology and new/emerging medications greatly expands available treatment options. Despite these various therapeutic options, current treatment is mainly directed at achieving visual stabilisation. Restoration of vision with newer agents is limited and not possible in every patient. Thus, early recognition and treatment to arrest the progression of neovascular age-related macular degeneration is the preferred means of attaining the best visual outcome.     

糖尿病性黄斑水肿治疗的研究现状

对于糖尿病患者,糖尿病性黄斑水肿(DME)是导致视力下降的原因之一,除了严格控制血糖和血压外,目前其主要治疗方法有:视网膜激光光凝、玻璃体切割手术、糖皮质激素药物、抗血管内皮生长因子药物。DME治疗的目的在于减轻黄斑水肿、提高视力,由于各种治疗方法都存在一定的优势,联合治疗在一定程度上能获得较好的治疗效果,成为目前研究的热点。     

糖尿病黄斑水肿抗血管内皮生长因子治疗进展

糖尿病黄斑水肿（DME）是导致糖尿病患者视功能损伤的主要原因之一,DME的治疗方法包括激光光凝治疗、抗炎治疗和抗血管内皮生长因子（VEGF）治疗。近年来,抗VEGF药物Ranibizumab、Bevacizumab、VEGF-Trap和KH902等对DME有良好的治疗效果。文章对DME抗VEGF治疗进展进行综述,探讨抗VEGF治疗的有效性和安全性。     

病理性近视脉络膜新生血管的治疗

病理性近视早期即可出现眼底病变且进行性加重,可导致视功能明显受损,其中脉络膜新生血管的发生是视力丧失的主要原因。文章对病理性近视的患病率、危害、自然转归、影响因素和治疗方法进行综述,着重探讨抗血管内皮生长因子药物治疗的进展。     

贝伐单抗在结直肠癌治疗中的研究进展

结直肠肿瘤是一种常见恶性肿瘤,在亚洲及东欧地区发病率迅速增长。对于早期结直肠肿瘤,手术依然是主要的治疗手段,而对于转移性结直肠癌,化疗则成为首选治疗。在过去的30年,结直肠肿瘤患者的病死率有所下降,但存活率仍有较大差别,原因可能有肿瘤的特性、宿主的反应性以及治疗方式的差别。转移性结直肠癌的治疗手段有化疗、抗血管内皮治疗和抗生长因子治疗。贝伐单抗是一种抗血管内皮生长因子抗体,已经被批准用于多种肿瘤,在结直肠肿瘤中得到广泛应用。     

糖尿病性黄斑水肿的药物治疗现状

糖尿病性黄斑水肿及增殖型糖尿病性视网膜病变是导致糖尿病性视网膜病变患者视功能损害的两大主要原因,其中糖尿病性黄斑水肿是非增殖型糖尿病病变视功能损害的主要原因。目前糖尿病性黄斑水肿的治疗包括眼底激光、药物及玻璃体手术。血管内皮生长因子及炎症因素在糖尿病性黄斑水肿发生发展过程中均起非常重要作用,且炎症因子及血管内皮生长因子相互刺激分泌,促进糖尿病性黄斑水肿的形成,因此药物主要包括抗血管内皮生长因子药物及皮质类固醇类药物。近年来,随着对抗血管内皮生长因子药物及皮质类固醇类药物治疗研究的不断深入,现就糖尿病性黄斑水肿的药物治疗现状作一综述。     

Rescue of retinal function by macular translocation surgery in age-related macular degeneration and other diseases with subfoveal choroidal neovascularization

Age-related macular degeneration (AMD) is the leading cause of legal blindness among the elderly. In AMD and some other macular diseases, subfoveal choroidal neovascularization (CNV) damages the underlying retinal pigment epithelium (RPE), and because retinal function is dependent on a healthy RPE, vision is markedly reduced by a subfoveal CNV. To treat such CNVs, macular translocation surgery has been performed to move the sensory retina from the damaged RPE to healthier RPE. At present, this surgery is the only possible treatment to improve the visual acuity of patients with subfoveal CNV. Macular translocation surgery involves the detachment of the entire retina from the RPE by a subretinal infusion of fluid and creating a 360 degrees circumferential retinotomy followed by the rotation of the retina. Severe postoperative complications such as recurrent retinal detachment have been reported in about 30% of the cases after macular translocation. To determine the efficacy of this surgery, it is necessary to demonstrate an improvement in macular and overall retinal function objectively as well as subjectively. To this end, we have assessed the changes in visual function by measuring the visual acuity subjectively, and the macular function objectively by focal macular ERGs (FERGs). We shall show that there is an improvement in the FERGs in most patients after retinal translocation surgery but the full-field ERGs were reduced by about 30%. Thus, macular translocation surgery with 360-degree retinotomy may be feasible for macular function, although some degree of peripheral retinal function is lost.     

Management of age-related macular degeneration

With the increase in life expectancy across the world, the magnitude of blindness due to age-related macular degeneration (AMD) is expected to rise. Exudative form is the major cause of visual loss from AMD. Several treatment options are available for this form of the disease. However, all treatment strategies aim at preservation of residual vision rather than regaining the lost vision. Two well-proven strategies are laser photocoagulation and photodynamic therapy. Other viable options are submacular surgery, transpupillary thermotherapy and pharmacological modalities like angiostatic-steroids. Oral anti-oxidants and zinc appear to be beneficial in preventing disease progression in early cases. Further research is on to explore more efficient treatments and to prove the safety and efficacy of large number of emerging newer treatment options.